GLP-1 Federal Policy Timeline: Government Actions on Price and Coverage
Since May 2025, the federal government has moved on GLP-1s through a most-favored-nation executive order, a deal setting about $245 per month for Lilly and Novo drugs in Medicare and Medicaid, a $274 Medicare negotiated price, and the BALANCE model. Here is each action in order.
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The federal government has taken four main actions on GLP-1 drugs since May 2025: a most-favored-nation pricing executive order (May 12, 2025), manufacturer deals that set a government purchase price of about $245 per month for Ozempic, Wegovy, Mounjaro and Zepbound (November 2025), a separate Medicare negotiation that set a $274 maximum fair price for Novo Nordisk’s semaglutide products effective January 1, 2027, and a voluntary coverage model called BALANCE announced December 23, 2025 [2][5][8][6]. Congress, meanwhile, has not changed the underlying law: Medicare still cannot cover weight-loss drugs [1][6], and the leading bill to fix that remains stalled over a $35 billion cost estimate [1].
The executive order led to letters to leading pharmaceutical manufacturers in July 2025, the first manufacturer agreement with Pfizer in September 2025, the TrumpRx website announcement, and then the GLP-1-specific deals and models in November and December 2025 [2][5][6]. Here is what each step actually did, and what it did not do.
Why can’t Medicare cover weight-loss drugs in the first place?
Federal law prohibits Medicare from covering weight-loss medications under a 2003 provision that treated these drugs as cosmetic [1]. That prohibition is still in force, and Medicare remains barred from covering GLP-1s solely for weight loss [6].
Many GLP-1s are covered today, but only for other conditions. Medicare Part D and state Medicaid programs frequently cover these drugs when they are prescribed for conditions such as type 2 diabetes [6]. On the Medicaid side, 16 state Medicaid programs cover GLP-1 therapies for obesity treatment, according to a KFF 50-state survey cited by ACHI [6].
What is the Treat and Reduce Obesity Act, and where does it stand?
The Treat and Reduce Obesity Act (S. 1973) would allow Medicare to cover anti-obesity medications, including GLP-1s, for people who are overweight and have one or more other medical conditions [1]. It has not passed.
The main obstacle is cost. The Congressional Budget Office estimated it would cost $35 billion over a nine-year period for Medicare to cover anti-obesity medications [1]. Supporters in both parties have spoken about the bill but have not committed to a timeline. Senate HELP Chair Bill Cassidy (R-La.), a cosponsor, said he would like to take action on GLP-1s but was noncommittal about when, citing other committee priorities [1]. Rep. Raul Ruiz (D-Calif.) said Medicare policy needs to stop viewing anti-obesity medications as “just cosmetic weight loss,” and Rep. Buddy Carter (R-Ga.) argued that coverage could save money down the road [1].
William Dietz, director of the STOP Obesity Alliance at George Washington University, framed the problem plainly: “The GLP-1s are a game changer. They’re an effective strategy for weight loss. The problem is expense” [1].
What did the May 12, 2025 most-favored-nation executive order do?
On May 12, 2025, President Donald Trump issued an executive order titled “Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients,” with the goal of ensuring Americans pay no more for prescription drugs than people in other developed nations [2].
The order directed the Secretary of Health and Human Services to communicate most-favored-nation (MFN) price targets to manufacturers, and if significant progress was not made toward those pricing structures, to propose a rulemaking plan to address the issue [2]. It also directed the HHS Secretary to facilitate direct-to-consumer purchasing programs for manufacturers selling their products at MFN prices [2][4].
On July 31, 2025, Trump sent letters to leading pharmaceutical manufacturers outlining the steps they must take to bring US prices down to match the lowest price offered in other developed nations [2].
What happened with Pfizer on September 30, 2025?
On September 30, 2025, Trump announced the first agreement with a major pharmaceutical manufacturer, Pfizer, to bring American drug prices in line with the lowest price paid by other developed nations [2]. According to the White House, the agreement would give every state Medicaid program access to MFN prices on Pfizer products, guarantee MFN prices on all new medicines Pfizer brings to market, require Pfizer to repatriate increased foreign revenue realized as a result of the administration’s trade policies, and require Pfizer to offer medications at deep discounts when selling directly to American patients [2].
Pfizer said many of its drugs and some specialty brands would see 50% savings on average on TrumpRx compared with buying the drugs without insurance [3][4]. The company also committed to $70 billion in US manufacturing and research investment and received a three-year waiver from the tariffs Trump had threatened, as long as it keeps production in the United States [4][3]. Pfizer CEO Albert Bourla said tariffs motivated the decision, after Trump had threatened 100% tariffs on imported drugs [3].
The initial Pfizer medicines named for TrumpRx were Eucrisa, Duavee, Zavzpret and Xeljanz [2].
What is TrumpRx, and does it sell drugs?
TrumpRx is a government-run direct-to-consumer website announced September 30, 2025, with a launch planned for “early 2026” [2][3][4]. It does not sell or distribute medications. Users search for medications on the site and are redirected to a direct-to-consumer channel from the manufacturer to make purchases [3][4].
The site is intended for people buying without insurance. Pfizer said its discounted rates through TrumpRx apply only for patients not using insurance [4]. Axios reported the program is unlikely to save much for the 92% of Americans with health insurance, and the Wall Street Journal reported that most insured patients probably pay less through their plans than they would at cash prices on TrumpRx [4]. Axios also noted, citing ABC News, that direct-to-consumer sites generally offer lower prices for cash but still higher than when using insurance [4]. Mark Cuban’s Cost Plus Drugs uses a similar model to TrumpRx, offering low-cost medications with transparent prices [4].
What did the November 2025 deal with Lilly and Novo Nordisk set?
In November 2025, Trump, Eli Lilly and Novo Nordisk signed a deal to cut GLP-1 prices for the government’s Medicare and Medicaid programs, as well as for cash payers [5]. NPR separately reported a November 6 deal with Novo Nordisk as part of the administration’s push for voluntary price cuts [9]. The agreement covers semaglutide (brand names Ozempic and Wegovy) and tirzepatide (brand names Mounjaro and Zepbound) [6].
Under the deal, prices for currently available injectable GLP-1s used for diabetes and other covered health issues would fall to about $245 per month to the government for patients in Medicare and Medicaid [5][6]. Medicare beneficiaries’ out-of-pocket costs would be capped at around $50 per month [6][5]. Weight-loss pills being developed by Lilly and Novo would cost $149 per month to the government for Medicare and Medicaid enrollees and to cash payers [5].
The $245 figure is a price the government pays, not a retail or cash price. The deal also expanded access in Medicare and Medicaid to people with a body mass index over 35, and people with BMIs above 27 who have additional health conditions, though the details of exactly how this will work remain unclear [9]. Novo’s obesity pill won US approval on December 22, 2025, while Lilly’s oral version remained under review at that time [5].
What did Medicare negotiate under the IRA, and when does the $274 price start?
Separately from the White House deal, CMS announced negotiated prices for 15 Part D drugs in the second cycle of the Medicare Drug Price Negotiation Program, with an initial price applicability year of 2027 [8][9]. The negotiation period ended November 1, 2025 [8].
For Ozempic, Rybelsus and Wegovy (all Novo Nordisk products), the negotiated price is $274 for a 30-day supply, effective January 1, 2027 [8]. That compares with a 2024 list price of $959 per 30-day supply (the wholesale acquisition cost), a 71% discount [8][9]. In 2024, that group of drugs accounted for $15,161,908,000 in Part D gross covered prescription drug costs, and 2,282,000 Medicare Part D enrollees used them [8].
The maximum fair price applies across dosage forms. CMS lists example package prices of $276.78 for one Ozempic 4mg/3mL pen, $276.78 for Rybelsus 7mg 30 tablets, and $385.63 for four Wegovy 2.4mg/0.75mL pens [8].
Across all 15 drugs, CMS estimated the negotiated prices would have saved about $12 billion in net covered prescription drug costs, roughly 44% lower net spending, if they had been in effect in 2024 [8][9]. That is a modeled estimate against 2024 spending, not realized savings. Including Coverage Gap Discount Program spending, the estimate is about $8.5 billion and about 36% lower [8][9]. In 2024, about 5.3 million of the 53 million people with Part D coverage used these drugs, which accounted for $42.5 billion in gross costs, about 15% of total Part D gross covered costs, and $1.7 billion in beneficiary out-of-pocket spending [8]. Discounts across the 15 drugs ranged from 38% for Austedo to 85% for Janumet [9].
Why is the negotiated price $274 when the deal says $245?
The two figures cover the same Novo Nordisk products but come from different processes, and the gap has not been explained. The November White House deal set about $245 per month for Ozempic and Wegovy under the MFN agreements, while the Medicare negotiation announced later in November set $274 per month for Ozempic, Wegovy and Rybelsus as the maximum fair price effective January 1, 2027 [9].
“It’s not clear why Novo [Nordisk] would promise a different price in two different venues,” said Dr. Benjamin Rome, a health policy researcher at Brigham and Women’s Hospital [9]. Novo Nordisk said in a statement that it looks forward to additional clarity from CMS on how pricing and coverage will work, and that the administration deal reflects a broader effort to expand access to obesity care across Medicare and Medicaid [9]. The company also said it remains opposed to government price setting [9].
| Price | What it is | Who pays it | When it applies |
|---|---|---|---|
| About $245/month | Government purchase price under the MFN agreements | Medicare and Medicaid programs | Announced November 2025 [5][6] |
| ~$50/month | Out-of-pocket cap for Medicare beneficiaries | Medicare beneficiaries | Under the November 2025 deal [6][5] |
| $274/30-day supply | Medicare maximum fair price for Ozempic, Rybelsus, Wegovy | Medicare Part D | Effective January 1, 2027 [8] |
| $149/month | Price for weight-loss pills in development | Government and cash payers | Announced November 2025 [5] |
| $959/30-day supply | 2024 list price (WAC) for comparison | Not a transaction price | 2024 baseline [8] |
What is the BALANCE model announced December 23, 2025?
On December 23, 2025, CMS unveiled a voluntary program to cover GLP-1 drugs for weight loss and diabetes under Medicaid and Medicare Part D [5]. The model is called BALANCE, short for Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth [6].
Under BALANCE, CMS negotiates directly with participating GLP-1 manufacturers. Negotiation areas can include guaranteed net pricing, out-of-pocket cost limits for beneficiaries, standardized coverage criteria across participating state Medicaid programs and Medicare Part D plans, and requirements to pair the therapies with broader lifestyle and nutrition interventions [5][6]. CMS said eligible Medicare beneficiaries will pay $50 for a month’s supply of GLP-1 drugs, including Wegovy and Zepbound [5].
Participation is voluntary for manufacturers, state Medicaid agencies and Medicare Part D plans [5][6]. Manufacturers seeking to participate had to respond to a request for applications by January 8 [6]. The CMS Innovation Center plans to launch the Medicaid arm on May 1, 2026, and the Medicare Part D arm on January 1, 2027 [5][6].
CMS indicated that additional information, including eligibility rules and benefit details, will be released later, and limited operational details were available at the time of announcement [6]. Expert reactions were mixed: some were optimistic the model would expand access, while others doubted CMS could negotiate lower prices than the insurers approved to offer Part D plans can, and questioned how many state Medicaid agencies would participate given the long-term budget exposure of chronic use of high-cost drugs [6].
What is the Medicare GLP-1 bridge demonstration?
CMS said it will roll out a Medicare GLP-1 payment demonstration in July 2026 as a short-term bridge to the BALANCE model, letting beneficiaries access the drugs at administration-negotiated prices [5][6]. The bridge is described as serving participating Medicare Part D plans [6].
What is Congress doing about compounded GLP-1s?
Lawmakers introduced bipartisan legislation, the Safeguarding Americans from Fraudulent and Experimental Drugs Act (S. 3794), to crack down on compounding issues by giving the FDA more authority over compounding facilities [1]. The bill would require compounding manufacturers to report activity to the FDA, mandate inspections, and set a limit on how many “copies” of a drug can be produced each month [1].
The FDA issued guidance recommending that compounded drugs be accessed only if an FDA-approved drug isn’t meeting the patient’s needs or an FDA-approved drug isn’t available [1]. Rep. Rudy Yakym (R-Ind.) said Americans deserve confidence that their prescription medications are safe, effective and made to the highest quality standards [1].
What do GLP-1s cost on TrumpRx right now?
A White House official said that through the manufacturer agreements, the administration has negotiated prices on most of the popular GLP-1s, which are typically not covered by insurance [1]. But costs for the different brands and forms of GLP-1 medications still range from $149 to $299 per month, according to information provided on the TrumpRx website, and some of those reduced costs only last for a limited time [1].
For context, Axios reported, citing ABC News, that direct-to-consumer sites generally offer lower prices for cash but still higher than when using insurance [4].
What is still unresolved, and what dates matter next?
Congress has so far resisted codifying the most-favored-nation policy, though a White House official said Congress is working with the administration on MFN legislative text, in line with the agreements made with drug manufacturers [1]. Joseph Nadglowski, president and CEO of the Obesity Action Coalition, said Congress could act once data on the cost effectiveness of the medications is available [1].
The statutory exclusion on Medicare coverage of weight-loss drugs remains in place unless Congress changes it. The dates to watch: the negotiated Part D prices, including the $274 semaglutide price, take effect January 1, 2027 [8]. The BALANCE Medicaid arm is targeted for May 1, 2026, and the Medicare Part D arm for January 1, 2027 [6]. The Medicare GLP-1 bridge demonstration is planned for July 2026 [5][6].
| Date | Action |
|---|---|
| May 12, 2025 | Most-favored-nation executive order issued [2] |
| July 31, 2025 | Letters sent to leading pharmaceutical manufacturers [2] |
| September 30, 2025 | Pfizer agreement announced; TrumpRx unveiled [2] |
| November 1, 2025 | Medicare negotiation period ends [8] |
| November 2025 | Lilly and Novo Nordisk GLP-1 pricing deal signed [5][9] |
| December 22, 2025 | Novo’s obesity pill wins US approval [5] |
| December 23, 2025 | BALANCE model announced [5] |
| Early 2026 | Planned TrumpRx launch [2][3][4] |
| May 1, 2026 | Planned BALANCE Medicaid launch [5][6] |
| July 2026 | Planned Medicare GLP-1 bridge demonstration [5][6] |
| January 1, 2027 | Negotiated Part D prices and BALANCE Medicare arm take effect [8][6] |
Sources
- Bloomberg Government. Congress Takes Fresh Look at GLP-1 Legislation on Cost, Safety.
- Healthcare Perspectives. Trump Administration Announces Deal with Pfizer on Most-Favored-Nation Drug Pricing and Launch of TrumpRx.
- HNGN. Pfizer to Slash Drug Prices as Trump Announces Launch of ‘TrumpRx’ Website. October 1, 2025.
- Axios. TrumpRx website: What to know about launch date, costs.
- Reuters. US health agency unveils weight-loss drug coverage model. December 23, 2025.
- ACHI. Trump Administration Announces New Voluntary Payment Model for Weight-Loss Drugs. January 6, 2026.
- Novo Nordisk. Financial report for the period 1 January 2026 to 30 June 2026. August 4, 2026.
- Centers for Medicare & Medicaid Services. Fact Sheet: Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2027. June 2023.
- NPR. Medicare negotiated lower prices for 15 drugs, including 71% off Ozempic and Wegovy. November 26, 2025.
- IntuitionLabs. Medicare Drug Price Negotiation List: All Drugs and Prices. August 1, 2026.
- Centers for Medicare & Medicaid Services. BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model.
- Medical Daily. The Federal Deal to Cut Medicaid Prices on Weight Loss Drugs Still Names No Participating States.
- The White House. Adjusting Imports of Pharmaceuticals and Pharmaceutical Ingredients into the United States. April 2, 2026.
- Federal Register. Adjusting Imports of Pharmaceuticals and Pharmaceutical Ingredients into the United States. April 9, 2026.
- Ropes & Gray LLP. 100% On Brand: U.S. Imposes New Tariffs (and Key Exemptions) on Patented Pharmaceuticals.
- Arnold & Porter. Trade Winds Shift for Pharma: Understanding the Section 232 Tariff Proclamation on Pharmaceuticals. April 6, 2026.
- Thompson Hine SmarTrade. President Trump Announces Section 232 Tariffs on Pharmaceuticals and Active Pharmaceutical Ingredients.
- Reuters. Trump says generic drugs to face no US tariffs for 2 years, then 100% and 200% tariffs later. July 21, 2026.
- AJMC. Trump Announces Timeline for 100% Generic Drug Tariffs Beginning in 2028, 200% in 2029. July 22, 2026.
- Centers for Medicare & Medicaid Services. Information for Pharmacies.
- National Council on Aging. Medicare GLP-1 Bridge Program: Eligibility, Costs, and Coverage.
- MIC Insurance Services. What Medicare Really Covers for GLP-1 Drugs in 2026. September 9, 2026.
- NPR. Drugstores say Medicare’s $50 obesity drug program is catching on. August 26, 2026.
- AARP. Medicare $50 GLP-1 Bridge Access and Eligibility.
- Newsweek. Medicare Update: Hundreds of Thousands Get GLP-1 Drugs for Just $50.
- KFF Health News. The Medicare GLP-1 Discount Has One Big Catch: Some Sick Patients Don’t Qualify. August 25, 2026.
- Reuters. Global pharma companies that have publicly announced Trump drug pricing agreements. September 1, 2026.
- Pharmaceutical Commerce. How GLP-1 Growth and Specialty Drugs Are Driving Cost Pressure. June 18, 2026.
- CNBC. Medicare will start covering obesity drugs for the first time. Here’s what patients should know. June 30, 2026.
- Federal Register. Improving Transparency Into Pharmacy Benefit Manager Fee Disclosure. January 30, 2026.
- Forbes. Why 2025 Could Be A Good Reimbursement Year For CVS And Walgreens. December 22, 2024.
- KFF. What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge. May 11, 2026.
- Obesity Medicine Association. Blog article on updates to Medicare coverage of GLP-1 medications.
- Mondaq. Advisory on the Section 232 tariff proclamation on pharmaceuticals.
Frequently asked questions
Does Medicare cover GLP-1s for weight loss right now?
No. Federal law still prohibits Medicare from covering weight-loss medications under a 2003 provision that treated them as cosmetic, and Medicare cannot cover GLP-1s solely for weight loss. Many GLP-1s are covered under Part D and Medicaid for conditions such as type 2 diabetes, and 16 state Medicaid programs cover them for obesity treatment.
What do the $245 and $50 figures in the November 2025 deal mean?
The about $245 per month is the price the government pays for currently available injectable GLP-1s under the MFN agreements for Medicare and Medicaid patients, not a retail price. The roughly $50 per month is the out-of-pocket cap for Medicare beneficiaries under that deal. Weight-loss pills in development were set at $149 per month to the government and to cash payers.
Why is the Medicare negotiated price $274 higher than the deal price $245?
The two figures come from different processes covering the same Novo Nordisk products, and the gap has not been explained. Dr. Benjamin Rome of Brigham and Women's Hospital said it is not clear why Novo Nordisk would promise a different price in two different venues. Novo Nordisk said it looks forward to additional clarity from CMS on pricing and coverage.
When do the negotiated Medicare prices start?
The negotiated prices for the 15 selected Part D drugs, including $274 for a 30-day supply of Ozempic, Rybelsus and Wegovy, take effect January 1, 2027. The negotiation period ended November 1, 2025. CMS estimated the prices would have saved about $12 billion in net costs if applied to 2024 spending.
Does TrumpRx save money if you have insurance?
Probably not for most people. Axios reported the program is unlikely to save much for the 92% of Americans with health insurance, and the Wall Street Journal reported that most insured patients probably pay less through their plans than cash prices on TrumpRx. Pfizer said its TrumpRx discounts apply only for patients not using insurance.
What is TrumpRx, and does it sell drugs?
TrumpRx is a government-run direct-to-consumer website announced September 30, 2025, with a launch planned for early 2026. It does not sell or distribute medications. Users search for prescriptions and are redirected to manufacturers' discount channels to make purchases.
How much does a GLP-1 cost if you pay cash on TrumpRx?
Costs for the different brands and forms of GLP-1 medications listed on the TrumpRx website range from $149 to $299 per month, and some of those reduced costs only last for a limited time. The administration says it negotiated prices on most popular GLP-1s through manufacturer agreements.
Who qualifies under the November deal's BMI criteria?
The deal expanded access in Medicare and Medicaid to people with a body mass index over 35, and people with BMIs above 27 who have additional health conditions. However, the details of exactly how this will work remain unclear, and CMS has said eligibility rules and benefit details will be released later.
This article summarizes FDA labeling, published research and company information current as of September 14, 2026. It is not medical advice and does not replace a conversation with your own healthcare provider. How we research and verify.